Nursing Care Plan for (NCP) Autism Spectrum Disorder

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Outline

Pathophysiology

Autism Spectrum Disorder (ASD) is a developmental and neurological disorder that affects how a person perceives, socializes, communicates and behaves. The term “spectrum” is used because patients can have a wide range of symptoms that begin in early childhood and may last through adulthood. There is no cure for ASD, but treatment can be effective in managing symptoms, including difficulty communicating with others and repetitive behaviors. Patients with ASD do not have physical characteristics that differentiate them from others, but typically have distant or awkward social behaviors that may make the interaction more difficult.

Etiology

There is no single known cause for ASD, but most researchers believe that genetic mutations, possibly inherited, are the primary reason for children to develop ASD.  Infants born extremely preterm (prior to 26 weeks’ gestation) and those with disorders such as fragile X syndrome and Rett syndrome are at increased risk of developing ASD. Children are screened at well visits with their primary provider beginning at 9 months and continue until 2-3 years old.

Desired Outcome

Patients will have an optimal ability to communicate needs and have optimal interpersonal relationships.

Autism Spectrum Disorder Nursing Care Plan

Subjective Data:

  • Difficulty sleeping
  • Irritability
  • Rarely showing enjoyment of objects or activities

Objective Data:

  • Failure to make eye contact
  • Overly focused interest in specific topics
  • Increased or decreased sensitivity to light, noise, touch, and temperature
  • Sing-song voice
  • Detailed memory

Nursing Interventions and Rationales

  • Perform nursing assessment progressively and slowly.
  Begin slowly with visual inspection and progress through assessment as the child begins cooperating. Fast movements can cause anxiety and fear.  Avoid anxiety as much as possible. Note any repetitive behaviors.
  • Obtain information and history from the patient’s parents regarding triggers for anxiety and behaviors, eating habits, and sleeping patterns.
  Determine baseline and expectations of how patients will react to the health care teams and procedures. Helps to determine the course of action and treatments and best practice for assessment of the patient.
  • Have parents complete evaluation screening questionnaires such as ASQ or M-CHAT appropriate for age.
  These are screening tools used at various ages and stages to determine in what areas the child may need assistance or therapy and severity of disability.
  • Provide for safety. Place infants or toddlers in the crib, raise rails on the bed.
  Many children with ASD also have seizure disorders. Provide for the safety of patients in case of seizure. Remove objects in the room that may cause injury in case of hyperactivity or anxiety.
  • Sit down or position yourself near the patient’s eye level.
  Patients may not make eye contact but may often feel apprehensive about others standing over them. Being at eye level helps ease anxiety and build trust.
  • Explain every procedure and demonstrate on self or parent
  Patients may be more cooperative if procedures such as using a stethoscope are first done on yourself or the parent.
  • Talk with the patient about their interests
  Evaluate communication abilities and develop rapport and trust.
  • Provide a calm and inviting atmosphere
    • Avoid loud noises, radios, talking
    • Turn off the TV during exam and evaluations
    • Limit number of people in the room to those whom the patient is most comfortable with
  Help the patient to feel more relaxed by avoiding excessive stimulation and distractions. Other children or siblings may need to be asked to leave if causing a distraction.
  • Review diet and eating habits with parents and provide or recommend foods and food presentations that may make healthy choices more appealing.
  Children with ASD often have aversions to food based on color, shape, or texture. Offering creative presentation ideas or ways of preparing foods may make them more interesting palatable for patients. Ensures more adequate nutritional balance.
  • Administer medications appropriately as required
  There are no medications to treat ASD, but some may be required to treat symptoms such as anorexia, inability to focus, depression, and seizures.
  • Provide resource information and education for parents
  • Help parents have less anxiety in caring for a child with ASD.
  • Provide information on how to manage symptoms or behaviors.
  • Help parents find therapists and counselors to help children with developmental disabilities.
  • Teach alternative methods for coping with behaviors.

Writing a Nursing Care Plan for (NCP) Autism Spectrum Disorder

A Nursing Care Plan for (NCP) Autism Spectrum Disorder starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for autism spectrum disorder. So autism spectrum disorder or ASD is a developmental and neurological disorder that affects how a person perceives, socializes, communicates and behaves. The term spectrum is used because these patients have a wide range of symptoms that begin in early childhood. It may last through adulthood. While there is no cure for ASD, treatment can be effective in managing symptoms, including the difficulty communicating with others and repetitive behaviors. Patients with ASD do not have physical characteristics that differentiate them from others, but they typically have distant or awkward social behaviors that may make interaction more difficult. So for some nursing considerations, the most important thing when taking care of a patient with autism spectrum disorder is to develop a trusting relationship. We want to assess and educate on the diet and we want to put them on some seizure precautions for safety. So the desired outcome; the patients are going to have optimal ability to communicate needs and have optimal interpersonal relationships. 

So this patient with ASD is going to come in to see us, and they are going to present with some subjective data. So some of the things that are very common with patients on the spectrum. They’re going to have difficulty sleeping insomnia. They’re going to have some irritability. They’re going to be very irritable. And they are also going to rarely show enjoyment of objects or activity. So, decreased enjoyment. And it doesn’t mean that they’re not actually enjoying themselves, they’re just not going to be able to show it because they process things differently. So some things that we are going to observe as nurses when we’re taking care of patients with ASD is we’re going to know that they have a failure to make eye contact. Okay. You often find them looking down or away from people when they’re talking, they’re going to be overly focused on specific topics. 

So if there’s someone with ASD or a child and they like dinosaurs, they are going to be obsessed with dinosaurs.That’s not necessarily a bad thing, but they’re going to be very focused on specific topics. They are also going to have either increased or decreased sensitivity to light noise and touch; and with touch, that also includes temperature. They’re going to have a sing-song, characteristic, sing, song, voice, and they’re going to have a very detailed memory. They are going to be able to recall everything that happened to them this past week. Word for word, minute for minute. So nursing interventions, what are some things that we can do in order to take care of these patients? Well, first we want to do a nursing assessment. We definitely need to do an assessment, but with this assessment, we want the assessment to be progressive and slow. We need to be mindful that these patients take a little more time to warm up to new people, new surroundings. We want to start with visually inspecting the patient, and then we can get to a physical assessment. As we begin to build a rapport, remember fast movements can cause anxiety and fear. The next thing we want to do is we want to talk to the patient about their interests, especially when they are older. So talk about interest. 

Of course, remember that this again is to evaluate their communication ability. So this is a part of our assessment, but it’s also going to develop rapport and trust. Okay? Next thing we want to do is we want to administer any medications that are appropriate and as required. while there are no medications to treat ASD, there may be some that are required to treat some symptoms of ASD, such as anorexia, the inability to focus. So decreased focus, depression, seizures. These can come along with ASD. So it’s important to use medications to treat these properly. The next thing is we want to review their diet. So let’s look at their diet because these patients with ASD tend to have special considerations. Maybe they like a certain shape or for a certain color of food. They like their food to be organized a certain way on the table. Maybe there’s one particular food that they like. We want to make sure that any aversions that they have that are food based on color, shape, or texture, that we can combat that and accommodate the patient. We want to offer creative presentations, ideas, and ways to prepare foods that may make them more interesting or palatable for the patients. And finally, we want to sit down and make eye contact with the patients. So sit down at the patient’s level. Remember patients may not make eye contact, but they do feel apprehensive about others over them. Being at eye level helps ease their anxiety and build trust. And that’s like the number one thing with these patients is we want to build trust. 

They’re gonna always remember how you made them feel. Let’s look at the key points. So remember ASD is just a neurological disorder that affects how a person perceives, how they socialize, how they communicate and behave. Some of the subjective data that we’re going to get is they may have some difficulty sleeping. They may be irritable. And the things that we are going to observe as nurses is we’re going to hear that characteristic sing-song voice. They’re going to have a failure to make eye contact. They’re going to have a very detailed memory. The number one thing we want to do with these patients is we want to build trust. That is number one, in any interaction with the patient, with ASD. We also want to make sure that we evaluate the communication abilities and develop that rapport. We also want to review their diet, remembering that reviewing the diet and eating habits and recommending foods and food presentations will make it easier for the patient to choose those snacks. We love you guys; go out and be your best self today. And, as always, happy nursing.

 

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